Annual Awards Dinner Reservations, Journal Entries & Grand Raffle Submissions 

 Reservations

 I would like to attend the annual awards dinner

Please make  reservation(s) $180 per person

Name 
 
Email address 
 
Company 
 
Address 
 
City
 
State     Zip
  
  


Name(s) of guests 

Seating Preference
Please list two names that you would like to be seated with 
 

Text for ad (please submit text below or email details to [email protected])   

I cordially request the following

 Resevations & journal ad  Reservations only  Journal ad only  I am unable to attend but would love to support this important cause and make a donation in the amount of $

Grand Raffle 

I would like to join the grand raffle by purchasing  1 raffle ticket $36  2 raffle tickets $60  3 raffle tickets $75  5 raffle tickets $100  10 raffle tickets $180

Journal options 

Please include my journal ad in the following category

 Sponsor $10,000***

 Platinum $5,000***

 Emerald $3,600***

 Diamond $2,500***

 Chai $1,800*** 

 Gold $1000**

 Silver $500**

 Full page $360**

 Half page $180*

 Quarter page $100

 Business card $50 

*** Journal ads of $1800 or entitle you to (10) dinner reservations

** Journal ads for $360 entitle you to (2) dinner reservations

* Journal ads  for $180 entitle you to (1) dinner reservation 

Please accept the sum of $  as payment for my dinner reservations, journal ad and raffle submissions (or any of the above)

 Please charge my credit card

Name on card  

Credit card number  

Expiration date  

Security code  

 I will mail a check to

Chabad of West Hempstead

411 Hempstead Turnpike

West Hempstead NY 11552